Removing Dorsal Hump Without a Tip Strut or Graft?

Doctor Answers 8

Tip struts are used if tip has poor support

June 18th, 2009

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It is possible to perform a dorsal hump without tip strut. Tip struts are only used when there is a very poor tip support as a preexisting condition. If the tip has good support to it, it does not need a tip strut. Once the hump is removed the sidewalls will most likely need to be narrowed with the rhinoplasty procedure.

Hump reduction alters the nasal profile

May 26th, 2009

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When contemplating nasal hump reduction, one must consider whether to carry this removal all the way to the supratip region inferiorly or up to the radix (top of the nose) superiorly. If one performs a hump reduction alone, generally speaking tip position is not affected. However, if some dorsal septum in the area of the anterior septal angle (end of the septum near the tip), tip rotation is generally created to some degree. That is, the opposite of tip ptosis occurs. Also, the illusion of tip projection often occurs if too much dorsum is resected or removed and this can create the appearance that the tip has been altered.

So in conclusion, while generally speaking conservative hump reduction does not result in alterations of tip position, over agressive hump reduction can affect tip position vis a vis rotation or ptosis.

No columellar strut is probably needed

May 22nd, 2009

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I'd have to see your nose to know how to provide what you want. Make sure you plan your nose on the computer first so you know what to expect. Your tip probably won't fall without a columellar strut graft. There are a lot of 'fads' in cosmetic surgery and columellar struts are one of them. Nature has designed the tip cartileges to stay up, and they usually do. The most common result of a columellar strut graft is to increase columellar show from a side view.

Tip and strut grafts are not always necessary.

Simply removing the dorsal hump by itself usually does not cause tip droop, unless significant disruption of other tip support structures in the process of getting to the hump.

On the other hand, even when the tip is manipulated there are other methods, such as a columellar setback, that obviate the need for a strut.

Because rhinoplasty is such a custom operation every time, these specifics are best left to your rhinoplastic surgeon. I particularly emphasize that no two rhinoplasties should ever be done the same way.

It's about balance

May 21st, 2009

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Good question. It definitely depends on how big your hump is and the quality of the tip of your nose before surgery. Strictly speaking, downsizing a hump alone will not make your tip droop more or lift it for that matter. What can happen is that the relationship between the upper two thirds (the dorsum) of your nose and lower third (the tip) will change such that after the removal of a hump the tip can 'look' more droopy because it is no longer adjacent to a dominating big hump.

If your surgeon is recommending tip support or tip changes after hump reduction I would tend to trust that recommendation. Something that can help is if you print out a large (almost life size) photo of yourself from the side showing your dorsal hump, then take a pencil and gradually sketch away the hump. Do this until you are satisfied with the appearance then look at the tip. If it looks OK that may be all that needs to be done, if it looks 'droopy' or 'ski slopeish' the tip work may be warranted. I hope that helps.

Columella struts are used to support the nasal tip

May 21st, 2009

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Dear Eire,

I agree with Dr. Fechner. The only reason to use a graft like this is if you're having work done to the tip of your nose. If you're only having a bump removed, and you want your nasal tip to remain the same, you shouldn't need one.

Removal of Nose Hump and Tip Graft

May 21st, 2009

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The answer to your question has to be "it depends". If your tip support is good, no additional grafting may be necessary. If tip support is poor or borderline, tip graft, strut or both may become necessary. In most noses, the hump does not represent a major tip support component and the hump removal has little impact on the tip itself.

Will the nasal tip drop after dorsal hump removal?

May 21st, 2009

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It seems like a simple question, but it is fairly complicated. It really depends on how your tip is supported. If your nasal tip has good intrinsic support, then the dorsal hump can easily be removed via a closed approach if that is the only thing being addressed with the rhinoplasty, and the tip left alone. On the other hand, if you have a "tension tip", where the tip support is poor, and really is dependent on the caudal septum, then the tip projection will fall along with any dorsal reduction. This can be predicted based on looking at lateral photographs (at rest and smiling), but the best way to discuss this issue is to visit with a rhinoplasty surgeon, have them examine you, and then discuss the issues.

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